Medial Parapatellar Approach to Intramedullary Tibial Nailing: Is there a difference in anterior knee pain when compared to a traditional approach?

Principal Investigator: David Rothberg
Keywords: Tibia fractures , knee pain , tibial nailing Department: Orthopedic Surgery Operations
IRB Number: 00043060 Co Investigator:  
Specialty: Orthopaedic Surgery, Orthopaedic Surgery
Sub Specialties: Orthopaedic Trauma
Recruitment Status: Enrolling by invitation

Contact Information

Kirby Corbey
kirby.corbey@hsc.utah.edu
801-213-3366

Brief Summary

Anterior knee pain is a common complaint of patient s who have received a tibial intramedullary nail for treatment of a tibia fracture. Proposed reasons for anterior knee pain include nail prominence, insertion site and placement of the skin incision and approach for insertion relative to the patellar tendon. This study will compare the incidence of anterior knee pain associated with different approaches for insertion of an intramedullary nail for tibia fractures. A semi-extended parapatellar approach, with the nail inserted with the knee in relative extension, will be compared to traditional approaches that require nail insertion with the knee in flexion. Randomization envelopes will be created using a randomly generated list. Envelopes will be provided to surgeons after a patient consents to participate.
 
The research begins when the patient is asked to join the study prior to operative treatment of their tibia fracture. Patients will be asked to complete the IKDC Subjective Knee Evaluation form at their standard-of-care 6mo and 1yr follow-up clinic visits to assess the amount of anterior knee pain the patient is experiencing and the PROMIS Physical Function CAT to assess physical function post-operatively. At the patient's election, the survey may be completed during their standard-of-care follow-up visit to the clinic or sent to them via mail and/or email. Scores will be compared among the two groups to assess differences in anterior knee pain. Conclusions will be drawn regarding the efficacy of the semi-extended parapatellar approach for tibial nailing in regards to anterior knee pain.

Inclusion Criteria

All patients, 18 years of age or older, who present to the University of Utah Medical Center for treatment of a tibia fracture that requires use of an intramedullary nail for fracture fixation.

Exclusion Criteria

Potential participants will be excluded if any of the following conditions is present: 1) prior operations about the knee; 2) neurovascular compromise; 3) ipsilateral fracture of the femur or proximal tibia not amenable to intramedullary nailing; 4) patients who are non-ambulatory; 5) patients who have ipsilateral fractures involving the ankle or foot; or, 6) a fracture pattern that requires the surgeon to use a surgical approach outside the assigned treatment arm.